Life insurance for pre-existing conditions: What you need to know

Life insurance companies assess pre-existing conditions to determine the associated risk, which may lead Finding life insurance for pre existing conditions in Canada can feel intimidating, but it’s more possible than most people realize. Whether you have diabetes, asthma, or a previous cancer diagnosis, insurers look at how well your condition is managed and your current health outlook. Most Canadians with pre-existing medical conditions are still eligible for life insurance. The key is understanding how underwriters assess risk, what options exist if you’re declined, and how to protect your privacy during the process.

In this guide, you’ll learn how to navigate pre-existing condition coverage, the different policy types, and how to find affordable protection that fits your needs. It is rare to be outright denied life insurance due to pre-existing medical conditions.

What is considered a pre-existing condition?

A health condition or medical history that exists before applying for or obtaining a life insurance policy. These conditions can affect an individual’s health, pose risks, or affect life expectancy. Failure to disclose pre-existing conditions could lead to complications when filing claims in the future.

Mild pre-existing medical conditions

Mild (1) pre-existing medical conditions are relatively common and manageable health conditions that may not significantly impact life insurance coverage. Examples can include:

• allergies,
• mild asthma,
• acid reflux, or
• minor joint/musculoskeletal issues

As a result, insurance premiums for individuals with mild pre-existing conditions are typically comparable to those without health issues. 

No waiting periods are usually specifically related to mild pre-existing conditions. Once the policy is in effect, coverage is generally immediate, and the policyholder is eligible for the full death benefit.

Serious pre-existing medical conditions

These are more severe or chronic health conditions that may require ongoing treatment and can significantly impact life insurance coverage. Examples can include:

• Heart disease: Heart disease involves various conditions affecting the heart, such as coronary artery disease, heart failure, or arrhythmias.
• Kidney disease: Kidney disease involves the impairment of kidney function, which can lead to the need for dialysis or kidney transplantation.
• Chronic obstructive pulmonary disease (COPD): COPD is a progressive lung disease characterized by breathing difficulties.
• Multiple sclerosis: Multiple sclerosis is a chronic autoimmune disease affecting the central nervous system.

Insurance companies assess these conditions as posing a higher risk, leading to potential increases in premiums or limitations in coverage options. The exact hike in premiums will depend on the severity and nature of the condition.

Family history

Family history itself is not considered a pre-existing condition. However, family history can play a role in determining your risk factors for specific health conditions.

Diabetes

Both type 1 and type 2 diabetes are common pre-existing conditions that can influence life insurance coverage.

• Type 1 diabetes: Type 1 diabetes is an autoimmune condition in which the pancreas produces little or no insulin. Life insurance companies typically consider type 1 diabetes a higher risk than type 2 diabetes, which is why the premiums may be higher.
• Type 2 diabetes: Type 2 diabetes is a metabolic disorder characterized by insulin resistance or inadequate insulin production. If diabetes is well-managed and there are no significant complications, some individuals with type 2 diabetes may be able to obtain life insurance coverage at standard or near-standard rates. Failure to manage the condition effectively or encountering complications can result in insurers imposing higher premiums or excluding coverage.

Asthma

Asthma is a chronic respiratory condition characterized by inflammation and constriction of the airways, resulting in symptoms like wheezing, coughing, and breathlessness. Asthma may be considered a mild pre-existing condition, mainly when well-managed and controlled. However, the severity and frequency of symptoms can affect the underwriting decision.

• Frequency and severity of symptoms: Insurance underwriters may want to know how often you experience asthma symptoms and whether they are mild, moderate, or severe. Severe and frequent symptoms may pose a higher risk.
• Treatment and medication: The medication you use to manage your asthma, such as inhalers or oral drugs, will be evaluated. The insurer will also consider if you have had any recent hospitalizations or emergency room visits due to your asthma.
• Control and management: The insurer may view your asthma more favourably if it is well-managed and stable, with no significant complications or limitations on your daily activities.

In some cases, individuals with well-controlled asthma may also be able to secure no-medical life insurance coverage.

Cancer(s)

The presence of cancer, either past or current, is a significant pre-existing condition. The insurance company will assess the type, stage, treatment, and duration of remission or recovery. Here are some key considerations:

• Type and stage of cancer: Different types of cancer have varying degrees of risk and prognosis. Insurance companies will evaluate the type and stage of cancer you have or have had and its potential for recurrence or metastasis. Cancers with better survival rates, such as early-stage localized cancers, may be viewed more favourably than advanced-stage or aggressive cancers.
• Treatment and response: The type of treatment received, such as surgery, chemotherapy, radiation therapy, or immunotherapy, will be considered. Insurance underwriters will also consider how well you responded to treatment and the duration of your remission or cancer-free period.
• Time since completion of treatment: The length of time since you completed cancer treatment is an essential factor. Typically, insurance companies prefer to see a more extended period of remission before offering coverage. The exact waiting period can vary between insurers, but it is generally a few years after completing treatment.
• Medical follow-up and surveillance: Consistent medical follow-up and surveillance for cancer recurrence, including regular check-ups, scans, and tests, are crucial. Demonstrating ongoing monitoring and compliance with recommended screenings can positively impact your insurability.

HIV/AIDS

Human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) is a severe pre-existing condition that can have a substantial impact on life insurance eligibility and premiums depending on various factors, including the individual’s current health status, treatment history, viral load, CD4 count, adherence to medication, and overall management of the condition. Here are some key considerations:

• Current health status: Insurance underwriters will assess the individual’s current health status, including the stage of HIV infection, any related complications or comorbidities, and overall immune function. Generally, individuals with well-controlled HIV infection and stable health may have more options for life insurance coverage.
• Treatment and adherence: The type of antiretroviral therapy (ART) used, treatment history, and medication adherence are essential factors. Consistent and successful adherence to ART, resulting in suppressed viral load and good immune function, can positively influence insurability.
• Viral load and CD4 count: Insurance companies may consider the individual’s viral load, and CD4 count indicators of their HIV infection control and overall health. Lower viral loads and higher CD4 counts generally reflect better disease management.
• Time since diagnosis: The length of time since HIV diagnosis is a factor. Insurance companies typically require a certain waiting period, often a few years after diagnosis, to assess stability and response to treatment.

Sexually transmitted infections (STIs)

Sexual contact, including vaginal, anal, or oral sex, primarily transmits sexually transmitted infections (STIs). Common examples of STIs include chlamydia, gonorrhea, syphilis, herpes, human papillomavirus (HPV), and HIV/AIDS, which may be considered pre-existing conditions and can affect life insurance underwriting. Here are some key points to consider:

• Pre-existing condition status: If you have been diagnosed with an STI before applying for life insurance, it may be considered a pre-existing condition.
• Type and severity of STI: The type and severity of the STI can impact life insurance. For example, certain curable STIs like chlamydia or gonorrhea might have minimal impact if they have been effectively treated and resolved. However, chronic or long-term STIs like herpes or HIV/AIDS may have more significant implications for coverage.

Dementia

Dementia refers to a group of cognitive disorders characterized by memory loss, impaired thinking, and difficulties with language, judgment, and behaviour.

• Diagnosis and type of dementia: Insurance companies will evaluate the type and stage of dementia. Common types include Alzheimer’s disease, vascular dementia, and Lewy body dementia. The stage and severity of dementia will influence coverage.
• Age at diagnosis: Insurability can be affected by the age at which dementia was diagnosed. Early-onset dementia, which occurs before age 65, is generally perceived as a higher risk compared to late-onset dementia.
• Progression and treatment: Factors such as the rate of cognitive decline, treatment response, and medication adherence can influence the insurer’s assessment.
• Activities of daily living (ADLs): Underwriters may assess the individual’s capacity to perform activities of daily living independently. Difficulties with ADLs, such as bathing, dressing, toileting, eating, and mobility, may affect the coverage and premiums.
• Time since diagnosis: Insurance companies typically require a waiting period after diagnosis to assess stability and response to treatment.

High blood pressure

Hypertension, also known as high blood pressure, is characterized by elevated blood pressure levels in the arteries, which can increase the risk of various health complications.

Insurance underwriters may consider your overall health status, including other medical conditions or risk factors contributing to high blood pressure, such as obesity, smoking, diabetes, or family history.

If you have experienced complications related to high blood pressure, such as heart disease, stroke, or organ damage, it may impact the insurer’s assessment. On the other hand, if your blood pressure is well-controlled through lifestyle modifications and medication, it may be viewed more favourably.

High cholesterol

High cholesterol is characterized by an elevated level of cholesterol in the blood. 

The insurer may consider your overall health status, including other medical conditions or risk factors contributing to high cholesterol, such as obesity, smoking, diabetes, or family history. Additionally, they may consider your lifestyle habits, such as diet and exercise.

If you have experienced complications related to high cholesterol, such as cardiovascular events (e.g., heart attack or stroke), it may affect the insurer’s assessment.

Stroke

When a stroke happens, there is a sudden disruption in blood flow to the brain, causing harm to brain cells and potentially resulting in a range of physical and cognitive impairments. 

A history of stroke is a severe pre-existing condition that can influence life insurance coverage and may result in higher premiums.

Type and severity of stroke: There are two types of strokes: ischemic stroke, resulting from a blood clot, and hemorrhagic stroke, which is caused by bleeding in the brain. Insurance companies will evaluate your stroke type, severity, and the resulting impairments.

• Ischemic stroke: Ischemic stroke, constituting about 80% of all strokes, is the most prevalent type. Insurers will evaluate the severity of the ischemic stroke and any enduring effects or disabilities resulting from the incident.
• Hemorrhagic stroke: This type of stroke is less common but typically more severe than ischemic strokes. Insurers will evaluate the severity of the hemorrhagic stroke, the location and extent of the bleeding, and the resulting impairments or disabilities.

Underlying causes and risk factors: These may include high blood pressure, high cholesterol, diabetes, smoking, obesity, and a family history of stroke. They will assess your overall health and the management of these risk factors.

The insurer will review the treatment received (such as rehabilitation and medication adherence) for the stroke and the subsequent recovery process. Adherence to recommended therapies and protocols can positively affect the insurer’s assessment.

Insurance companies typically require a waiting period to assess stability, response to treatment, and overall recovery before offering coverage.

Transplant

A transplant is a surgical procedure in which a healthy organ or tissue is replaced with a donated organ or tissue from another person. The effect of a transplant on life insurance coverage and premiums depends on several factors, including the type of transplant and the individual’s overall health.

Types of transplants

• Solid organ transplants: Solid organs typically include the heart, lungs, liver, kidneys, and pancreas. Insurance providers generally consider solid organ transplants to pose an elevated risk, given the potential for complications and the requirement for continued use of immunosuppressive medications.
• Bone marrow transplants: Also known as hematopoietic stem cell transplants, bone marrow transplants are used to treat conditions such as leukemia, lymphoma, and certain genetic disorders. However, due to potential complications and the underlying health conditions they are used to treat, bone marrow transplants may also be seen as higher-risk procedures.

How do insurance companies find out about your pre-existing condition?

Life insurance companies typically access medical records through the applicant’s consent. When an individual applies for life insurance, they must consent for the insurance company to request and access their medical records. Insurers verify the information provided by applicants through various means:

• Verification of driving records: Insurance companies may obtain an individual’s driving record from the state department or DMV to check for recent traffic violations, DUIs/DWIs, or reckless driving convictions.
• Medical Information Bureau (MIB): The MIB adheres to privacy regulations and laws in Canada, including the Personal Information Protection and Electronic Documents Act (PIPEDA), to ensure the confidentiality and security of personal and medical information for individuals. Insurance companies in Canada can access the MIB database to gather information about an individual’s previous applications for insurance, medical conditions disclosed, and other relevant details.
• Review of prescription drug databases: Insurers may review an applicant’s prescription drug history to gather information about medication dosages, fill dates, and contact details of pharmacies or physicians.

When submitting a life insurance application, applicants must consent for insurers to collect and verify this data.

Disclosure of pre-existing conditions

• When applying for coverage, you must provide accurate and complete information about their health status, including their medical history. Failure to disclose pre-existing conditions can have serious consequences. Here’s what could happen:
• Policy denial: If you omit or intentionally withhold information about a pre-existing condition, the insurance company may deny your application for coverage. Please disclose a pre-existing condition to ensure this requirement is met and avoid the rejection of your application.
• Policy rescission: Even if your policy is initially approved, the insurance company can rescind the policy if it is discovered later that you withheld information about a pre-existing condition. This means they can cancel the coverage, retroactively void the policy, and refund any premiums paid (in some cases). 
• Claim denial: If you fail to disclose a pre-existing condition and pass away, your beneficiaries may face difficulties filing a claim. The insurance company can investigate your medical history during the claims process. If they find out that you withheld information about a pre-existing condition, they may deny the claim, leaving your beneficiaries without the intended death benefit.
• Legal consequences: Providing false or misleading information on an insurance application is considered insurance fraud, a serious offense. If it is proven that you intentionally withheld information about a pre-existing condition, you could face legal consequences, including fines.

How life insurance companies evaluate medical conditions

During underwriting, the insurer assesses the applicant’s health status and pre-existing conditions based on some factors as follows:

• Medical history: Insurers assess the nature, severity, and stability of the pre-existing condition, including diagnoses, treatments, surgeries, medications, and any ongoing medical conditions. The greater the severity of your diagnosis, the higher the cost of life insurance will be.
• Current health status: If the individual has good overall health and the pre-existing condition is well-controlled, it may lead to lower premiums.
• Treatment and medications: Insurers examine the treatment plan, including prescribed drugs and their dosage. They consider the effectiveness of the treatment and the applicant’s adherence to the recommended regimen. Having fewer prescribed medications and maintaining consistent prescriptions and dosages over time can lower insurance rates.
• Risk factors: Insurers evaluate other factors that may influence the pre-existing condition. For instance, someone with diabetes who also has high blood pressure and engages in excessive alcohol consumption may experience a worsening of their medical condition.
• Prognosis and long-term outlook: If the prognosis is favourable and the condition is not expected to significantly affect life expectancy, you may get cheaper premiums. However, if insurers are concerned about the likelihood of complications or progression of the condition over time, it can result in higher premiums.

Insurers assign an appropriate risk classification to the applicant based on evaluating these factors in determining the life insurance policy premiums. Applicants with more severe or unstable pre-existing conditions may be classified as higher risk and may face higher premiums or potential limitations in coverage.

How do pre-existing conditions affect life insurance?

Life insurance applicants with pre-existing conditions can lead to varied outcomes based on specific circumstances.

• Approval with standard premiums: If your pre-existing condition is considered mild or poses minimal risk to the insurance company, you may be approved for the policy with standard premiums. This means you would pay the same premium as individuals without the pre-existing condition.
• Approval with higher premiums or rating: If your pre-existing condition is deemed more significant or carries a higher risk, the insurance company may approve your application but apply a rating. This means you would pay a higher premium than individuals without the condition. The rating can be temporary (for a limited period) or permanent (for the duration of the policy).
• Approval with exclusions: In some cases, the insurance company may approve your application but include exclusions related to your pre-existing condition. For example, the insurer may exclude coverage for heart-related events if you have a heart condition. This means that if you were to pass away due to a heart-related event during the exclusion period, the policy may not pay out a death benefit related to that condition.
• Approval with a waiting period: In certain situations, the insurance company may approve your application but impose a waiting period. During this period, the policy may have limited coverage or only provide a partial death benefit if you were to pass away. The waiting period allows the insurance company to assess the stability of your pre-existing condition before providing full coverage.
• Approval with limited coverage: The insurance company may offer coverage but with certain coverage limitations, such as placing a cap on the maximum benefit amount for expenses related to the condition or restricting coverage to specific treatments or medications.
• Application postponed or denied: In some instances, the insurance company may choose to delay or reject your application due to the severity or recent changes in your pre-existing condition. They may request additional medical information or further evaluation or suggest reapplying later.

Types of life insurance for pre-existing conditions

Traditional life insurance

Traditional life insurance policies, including term and permanent life insurance, can be available to individuals with pre-existing conditions but higher premiums. The underwriting process for these policies may involve a thorough evaluation of the condition, medical history, and overall health. 

Guaranteed-issue life insurance

This type of life insurance is specifically designed for individuals with a pre-existing condition who may have difficulty obtaining traditional coverage. It does not require a medical exam or health questions, so applicants are guaranteed acceptance regardless of their health condition. Simplified issue life insurance is based on a medical questionnaire but does not require a physical examination. However, the coverage amounts may be lower, and the premiums are generally higher than those for traditional life insurance policies.

Simplified-issue life insurance

This type of life insurance is another option for individuals with pre-existing conditions. While these policies may not require a medical exam, they typically involve answering health-related questions during application. Simplified issue life insurance has higher coverage levels and lower premiums than guaranteed life insurance. The coverage amounts and premiums may vary based on the severity and nature of the pre-existing condition.

Can you be denied life insurance because of a pre-existing condition?

You may be denied life insurance coverage. Each insurance company has underwriting guidelines and risk tolerance. One denial does not necessarily mean all insurers will provide the same response. While one company may deny coverage, another may offer coverage with specific limitations or higher premiums.

• Heart disease with recent complications: Someone who has recently experienced a heart attack or other significant cardiac event may face difficulty in obtaining coverage due to the increased risk of future cardiovascular complications.
• End-stage renal disease: An applicant with advanced kidney failure requiring dialysis or on the waitlist for a kidney transplant may be denied coverage due to the substantial health risks and potential complications.
• Terminal illness: Individuals with a terminal disease with a short life expectancy, such as advanced-stage ALS or stage IV metastatic cancer, may be denied coverage due to the imminent mortality risk.
• Guaranteed life insurance typically pays a small death benefit, generally between $25,000 to $50,000.

What should I do if I am denied life insurance?

If you are denied life insurance coverage, here are some steps you can take:

• Seek clarification: Ask the insurance company for the specific reason for the denial. Understanding the basis for the decision can help you assess your options and determine if any inaccuracies or factors can be addressed.
• Shop around: Just because one insurance company denied coverage doesn’t mean others will do the same. Explore other insurance providers and work with an expert insurance broker or agent who can help you find companies that specialize in covering individuals with pre-existing conditions.
• Review alternatives: Consider alternate types of life insurance, such as guaranteed-issue or simplified-issue. These policies have less stringent underwriting requirements and can provide coverage, although they may come with certain limitations or higher premiums.
• Improve your health: If your denial was based on specific health factors, take steps to improve your health. Work with healthcare professionals to manage your condition, make positive lifestyle changes, and demonstrate a track record of improved health over time. This may increase your chances of obtaining coverage in the future.
• Appeal or reapply: You may have the option to appeal or reapply after a certain period. Consult with the insurance company or seek guidance from an insurance professional to determine the best course of action.
• Seek professional advice: Insurance can be complex, especially when dealing with pre-existing conditions. Consult with an experienced insurance professional or company specializing in cases like yours.

Life insurance for pre-existing conditions – Conclusion

Having a pre-existing condition shouldn’t stop you from protecting your loved ones. By understanding how insurers assess risk and exploring non-traditional policy options, you can still secure meaningful coverage. Every insurer views conditions differently, so comparison matters.

If you’re ready to see what’s available for your health profile, get a personalized life insurance quote with Oneday. Coverage for eligible applicants is subject to underwriting and provincial regulation.

Frequently asked questions about life insurance with medical conditions Canada

Sources:

FCAC, “Optional mortgage insurance products”

Assuris, “How Am I Protected?”